BREXPIPRAZOLE AS ADJUNCTIVE THERAPY FOR BORDERLINE PERSONALITY DISORDER : A CASE REPORT Open Access

Borderline personality disorder (BPD) is a severe, difficult-to-treat psychiatric disorder that causes significant emotional distress as well as a significant financial burden on health-care systems.

BPD is distinguished by a pervasive pattern of affective instability, difficulty with impulse control, and aggressive outbursts. Although psychotherapy has been shown to reduce BPD symptoms, not all patients can tolerate it. Medication research is ongoing, but no drug has been approved by FDA for the treatment of BPD. 1-2Brexpiprazole is a novel serotonin-dopamine activity modulator with partial agonist activity at 5-HT1A and D2/D3 receptors and strong antagonist activity at 5-HT2A, a1B, and a2C adrenergic receptors. Furthermore, given the low rates of side effects reported in clinical trials for other disorders to date, brexpiprazole should be well tolerated in people with BPD. 2-3

The case report discusses the use of brexpiprazole as new generation antipsychotic in reducing BPD’ s symptom.

Miss Z, 20 years old female, university student, reported that she was drunk alcohol excessively to cope with her anxiety. Moreover, she had self-harm behaviour to overcome her negative thought. She felt emptiness and difficult to describe her emotion chronically. She reported low motivation to go to school, unable to enjoy her activity, difficulty of sleep. Furthermore, she reported low self-esteem and perceived burdensomeness. She was afraid of abandoned by her boyfriend. Although her boyfriend had cheated on her, she tried to be with him. That made her self-esteem became worse. Besides her activity as a student, she had a part-time job as a model. She took great care of her weight and appearance. She was given escitalopram 10 mg once daily and brexpiprazole 1 mg half a day. After taking the medication for 8-weeks, her emotion improves. She had good quality of sleep, reduction of self-harm behaviour and came back to school.

Brexpiprazole appears to have some effect on the symptoms of BPD.

Although the neurobiology of BPD is not fully understood, it appears to involve dysfunctions in the serotoninergic and dopaminergic systems. Brexpiprazole is partial agonist activity at 5-HT1A and D2/D3 receptors. As a result, they may be uniquely positioned to help with both mood symptoms and reward processing in BPD.

1.Diagnostic and statistical manual of mental disorders : DSM-5-TR / American Psychiatric Association. Copyright © 2022 American Psychiatric Association

2.Grant JE, Valle S, Chesivoir E, Ehsan D, Chamberlain SR. A Double-Blind, Placebo-Controlled Study of Brexpiprazole in the Treatment of Borderline Personality Disorder. Br J Psychiatry. 2022 February ; 220(2): 58–63. doi:10.1192/bjp.2021.159.

3.Del Casale A, Bonanni L, Bargagna P, Novelli F, Fiasche F, Paolini M. et al., Current Clinical Psychopharmacology in Borderline Personality Disorder. Curr Neuropharmacol.2021 Oct 18; 19(10): 1760–1779.